Leslie Kane, MA
Executive Editor,
Medscape Business of Medicine
Disclosure: Leslie Kane, MA, has disclosed no relevant financial relationships.
Compare Compensation Across 25 Specialties
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The mean income for internists was $166,000 in 2011, somewhat more than what family physicians earned in the same time period. Almost one quarter of internists earned $100,000 or less, probably because many work part-time. A minority of internists were high earners: About 6% earned $300,000 or more, compared with just less than 9% who earned that amount a year ago.
For employed internists, compensation includes salary, bonus, and profit-sharing contributions. For partners, compensation includes earnings after tax-deductible business expenses but before income tax. Compensation excludes non-patient-related activities (eg, expert witness fees, speaking engagements, and product sales).
Approximately 4 in 10 internists saw virtually no difference in income between 2011 and 2010. This was true for physicians in all specialties. More internists (37%) saw an increase in their earnings than a decline (21%). However, in last year's survey, only 13% of internists saw a decrease in income.
The gap in earnings between male and female internists has slightly narrowed. Male internists reported a mean compensation of $175,000 as compared with $149,000 mean earnings for women, which is 17% more. The gap was slightly more in last year's survey. Overall, male physicians across all specialties earned 40% more than their female counterparts, and male primary care physicians earned 23% more than female primary care physicians. According to Tommy Bohannon, divisional vice president of Merritt Hawkins (a physician recruitment firm), more female physicians work part-time, which contributes to an overall lower income.
Internists who are members of office-based multispecialty group practices earned the most in 2011, at a mean income of $194,000 -- up $12,000 over the previous year. Respondents in solo practices came in second, at $183,000, followed by internists in single-specialty groups, at $172,000 -- a slight decrease.. Internist employees of outpatient clinics and academia or government earned the least.
Physicians across all specialties are nearly evenly split about whether they feel fairly compensated. For internists, whose compensation is among the lowest of the specialties surveyed, a majority (55%) said that they are unfairly compensated for their work. In comparison, 48% of primary care physicians in the 2011 survey said that they were unfairly compensated for their work.
The vast majority of physicians don't consider themselves to be rich, and that's true for internists as well. Although the public may perceive most physicians as wealthy, only 8% of internists agree with that characterization. A majority (51%) said that they don't feel rich because their income is no better than that of many nonphysicians, while 41% feel the same way because of so many debts and expenses. These figures are virtually identical to those among family physicians.
The largest percentage (28%) of internists spends 30-40 hours per week seeing patients, as compared with 29% in last year's survey. Another 17% of respondents spend less than 30 hours per week with patients (compared with 13% last year), while 14% report spending more than 60 hours per week seeing patients.
The number of patient visits per week for internists is stable. About 23% have 50-75 patient visits per week. Some 19% have 76-99 patient encounters. A smaller percentage is really packing them in: About 10% of internists have more than 125 patient visits per week (compared with 12% last year). In contrast, 12% have fewer than 25 visits per week.
Survey results show that patient visits with internists are generally substantial. About 28% of internists spend 13-16 minutes with each patient, and 26% spend 17-20 minutes; both of these values are about the same as in the previous year. Only 3% of visits are less than 9 minutes long, whereas about 17% of internists conduct patient visits of 25 minutes or more.
The amount of time per patient visits excludes the patient's time with a nurse practitioner, physician assistant, or medical assistant; it measures only time spent in the presence of a physician.
Paperwork and administrative tasks take up a significant portion of time for internists. A majority (42%) spends 1 to 9 hours per week on paperwork and other non-patient-related activities, slightly more than in last year's survey and about the same as for family physicians. About 10% of internists spend 25 hours or more per week on administrative chores.
Physician frustration is growing. The 2012 report shows far more dissatisfaction among doctors across all specialties. Still, internists seemed more contented with a medical career than did the overall group of physicians. About 61% of internists would choose a career in medicine if they could do it all over again -- just 9% less than in last year's survey. This is higher than for physicians in all specialties, where just over one half would go into medicine again. However, only one quarter of internists would choose the same specialty, down from 41% a year ago. In addition, only 17% of internists would choose the same practice setting, compared with 44% last year.
Despite the interest in alternative patient-care delivery models, only a small percentage of internists are currently involved. About 5% participate in Accountable Care Organizations (ACOs), but 8% say they plan to do so in the coming year. Only 2% of internists have concierge practices, and 2% have cash-only practices, about the same proportion as for physicians in all specialties. Typically, such practices are more often found in primary care than in specialties.
An ACO is a type of payment and delivery model that ties provider reimbursement to quality metrics and reduction in the total cost of care for an assigned patient population. An ACO may initiate bundling of payments for various clinical outcomes. About 46% of internists surveyed believe that ACOs will cause a decline in income, while 15% say that they will have little or no effect on income. About 39% of internists said it's too soon to tell.
Elements of healthcare reform entail following treatment and quality guidelines set by insurers and Medicare for shared savings programs, but physicians are clearly skeptical that they will improve patients' quality of care. About 34% of internists said these measures will lead to better patient care, compared with 25% of physicians across all specialties. About 35% of internists believe the guidelines and quality measures will have a negative effect, while 30% said that they will have no impact on the quality of patient care.
Almost one third of internists said that they have no intention of reducing the amount of tests, procedures, and treatments they perform because they believe that the quality guidelines and cost containment measures aren't in patients' best interest. Almost half (43%) of all physicians agree. Another one quarter of internists said that they won't change their testing and procedure recommendations and intend to continue practicing defensive medicine, compared with 24% for all physicians surveyed. About 36% of internists said they would reduce the number of tests and procedures because the guidelines are valid; 1 in 4 physicians overall (27%) said the same. Another 9% of internists would reduce tests and procedures because the guidelines will affect their income.
Some 46% of internists said that they occasionally discuss cost of care issues if the patients raise the subject. Another 36% of internists said they regularly discuss cost issues with patients; that's slightly less than for physicians overall. Some 11% never discuss the issue because they themselves don't know the cost of the treatments, while 6% said they never discuss it because they don't believe it's appropriate to do so.
Captions written by:
Mark Crane, Freelance writer, Brick, New Jersey
Disclosure: Mark Crane has disclosed no relevant financial relationships.
